PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
1. LIST OF RELATED ACTIVITIES This activity is linked to PEPFAR treatment, care and prevention programs and Supply Chain Management Systems (#8817), JHPIEGO (#8821) and Danya Int. (#8824) injection safety initiatives. It supplements the track 1 JSI-MMIS activity (#6926) in injection safety.
2. ACTIVITY DESCRIPTION This activity relates to the prevention of HIV transmission among health care workers, medical waste handlers and the community. These funds will enable JSI Making Medical Injections Safe (JSI-MMIS) to scale up injection safety interventions through activities that build on internationally accepted strategies to health care facilities in Coast, Rift Valley and Nairobi Provinces. The World Health Organization (WHO) estimates of global burden of disease suggest that unsafe injections around the world account for 5% of HIV infections, 32% of hepatitis B virus infections and 40% of hepatitis C virus infections. A 2004 survey by JSI-MMIS in Kenya revealed that over 70% of respondents received an average of 1.5 injections per year. Needle stick injuries within the previous six months were reported by 58% of health care workers. These findings support those of an earlier study by the University of Nairobi among 214 nurses in Nairobi, which reported 61% needle stick injuries in health care workers over a three-month period. Needle recapping accounted for 46% of the injuries while 12% occurred in the process of sharps disposal. A majority of health facilities surveyed reported having experienced a shortage of disposable injection supplies in the 12 months prior to the survey, particularly in the curative sector. This reflects a less than optimal logistics system for forecasting, procurement, distribution and stock monitoring that may contribute to re-use of injections. Analysis of the status of injection logistics in the country revealed that there was no data to support rational forecasting of injection requirements. Procurement was based on previous consumptions. Appropriate product selection was poor due to lack of national standards for injection devices, registered suppliers of injection equipment and an appropriate board to handle non-pharmaceutical equipment. The JSI-MMIS activity commenced in Kenya in 2004 under PEPFAR. The activity aims to: 1) improve training of health workers and managers on safe injection practices, infection control and disposal procedures; 2) institute an advocacy strategy to decrease demand for injections by the population; 3) establish reliable estimates of re-use prevention injection device equipment requirements, minimum stock levels and effective supply and distribution systems for re-use prevention injection device equipment; 4) institute monitoring and supervision procedures to ensure adequate supplies at all levels and correct practices by health workers; 5) ensure safe disposal of used injection equipment through the progressive introduction of appropriate incinerators; and 6) secure the required budget for injection safety and infection control including safe disposal of used equipment. Significant changes in FY 2007 include scale up of activities to Coast province as well as total coverage of Kenyatta National Hospital in addition of continuation of services in Central province. In FY 2006 JSI-MMIS received country funds to facilitate faster expansion towards national coverage. It is expected that national coverage will be achieved by 2008 through this intervention. The Ministry of Health has committed to increase procurements of auto- disable injection devices and health care waste disposal containers as well as increased guidance and supervision for injection safety and infection prevention and control at health care facilities.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA This activity will reduce at least 5% of HIV transmission in the intervention regions of Kenya. In 2004 safe injection practices were introduced to two of 74 districts in Kenya. 243 health care workers, 30 logistics officers and 103 health waste handlers were trained in 2004. All health care facilities in Kiambu and Bondo districts were issued with re-use prevention injection commodities and sharps waste disposal boxes. In the following year 234 health care workers, 48 logistics officers and 92 medical waste handlers in Nyanza and Western provinces were trained on safe injection practices. The level of funding precluded extension of activities beyond the Kakamega and Nyanza Provincial Hospitals. These were, however, used as model sites for outlying health care facilities. COP funds in FY 2006 allowed intervention into Central Province and part of the Kenyatta National Hospital with training of 400 individuals (health care workers, logistical officers and medical waste handlers). In FY 2007 an additional 400 health care workers will be trained in Nairobi and Coast provinces.
4. LINKED ACTIVITIES The injection safety initiative is linked to the Ministry of Health Infection Prevention and
Control Program, the National AIDS and STD Control Program (NASCOP) Nosocomial TB/HIV Prevention Unit and Kenya Expanded Program for Immunization (KEPI) which already procures non re-use injection devices for its program. Other Kenyan stakeholders in the area of injection safety have been mobilized including the country World Health Organisation (WHO), National AIDS Control Council (NACC) and local training institutions including the University of Nairobi and Kenya Medical Training College. A National Injection Safety Steering Committee has been established at the Ministry of Health chaired by the Deputy Director of Medical Services and Head of Preventive Health Services. Membership to this committee is drawn from all the programs at the MOH and incorporates the National Environmental Management Authority (NEMA), World Health Organization (WHO), National AIDS Control Council (NACC), University of Nairobi and Kenya Medical Training College.
5. POPULATIONS BEING TARGETED This activity targets health care workers, the community, medical waste handlers, and policy-makers.
6. EMPHASIS AREAS This activity has major emphasis on training to impart improved skills, knowledge and attitudes regarding safe injection practices to health care workers, waste handlers and the community. A second area of emphasis will be commodity procurement of re-use prevention injection devises, sharps disposal containers and needle removers for intervention hospitals. This activity will also guide the development of policies to ensure adequate supplies of appropriate injection supplies at health care facilities.
